The Big Sleep

Women are popping sleeping pills like Altoids—should we worry?

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I've always loved sleeping pills. The warm snoozy bath of a Xanax, the velvet cloak of an Ambien, the emphatic "Oh, yes!" to the question, "Will I sleep tonight?" Love them. I'm not the only one: American pharmacies dispensed more than 43 million prescriptions for sleep aids in 2005, an almost 60 percent increase from 2000. College-educated women over 35 are more likely to experience trouble sleeping and to medicate themselves for milder sleep problems. And the National Sleep Foundation found that 15 percent of women were taking a prescription sleeping pill at least a few nights a week.

These drugs are not Flintstones vitamins: Most are controlled substances with side effects ranging from nausea to daytime grogginess, sleepwalking, and dependence. While a lifetime of soul-crushing insomnia has made me pretty cavalier about tranquilizers, I have to wonder—could we love them a little too much?

"I'm not encouraging people to take drugs, but sleep is a basic, core, biological process and the lack of sleep has serious consequences," says Neil B. Kavey, MD, director of the Sleep Disorders Center at Columbia University Medical Center. "I wouldn't avoid sleeping pills just in the interest of avoiding medications."

Recent science has linked insomnia to everything from obesity to anxiety, diabetes, lowered immunity, heart disease, and car accidents. Plus, bad sleep begets worse sleep: Not only does your brain's sleep-wake cycle become more aberrant as insomnia progresses, your habits fall apart (more coffee, more naps, etc.). To push through the fatigue, "you put your system into overdrive," Kavey says. Your adrenaline starts flowing and "now you feel anxious and stressed." Which makes it even harder to sleep the next night.

So nipping insomnia in the bud with a pill isn't necessarily a bad idea. The drugs most often prescribed for insomnia are: benzodiazepines (Ativan, Valium, Xanax), which work by stimulating the activity of the relaxation-inducing neurotransmitter GABA in the brain, causing sedation; non-benzodiazepine hypnotics (Ambien, Ambien CR, Lunesta, and Sonata), which work similarly to benzos but only bind GABA to sleep receptors; Rozerem, which targets melatonin receptors, and is the only prescription sleep aid that isn't a controlled substance; and antidepressants, which may work through a sedative effect or by decreasing anxiety.

Benzodiazepines and the GABA-enhancing hypnotics have the greatest risk for abuse because they can give you a high. However, few insomniacs get into this kind of trouble: Despite skyrocketing use, the number of benzodiazepine abusers has remained flat over the past decade, according to the National Institute on Drug Abuse. Of course, taking these drugs as prescribed will not prevent you from becoming physically or psychologically dependent: Going on them for an extended period (weeks or months—not just a few days) can lead to tolerance and experiencing withdrawal—which can include a racing heart, "rebound insomnia," or even seizures—if you abruptly stop. But this still doesn't mean you're addicted.

Even if you can take a sleeping pill every night for the rest of your life without ending up in a 12-step program, it's better to sleep without them. All these drugs can alter healthy sleep architecture, the pattern of dreaming and deep and light sleep your brain normally follows. Further, while abuse is rare, psychological dependence is common. "I do think the drugs are overused," says Paul B. Glovinsky, PhD, clinical director at St. Peter's Sleep Center in Albany, New York, and the coauthor of The Insomnia Answer, "because people lose confidence in their own ability to sleep." Anyone taking sleeping pills should be under the care of a physician and should also be improving her sleep hygiene (cut out caffeine, nicotine, and alcohol; go to bed and get up at the same time no matter how little you slept; limit naps; use your bed only for sex and sleep; get regular exercise but not before bed). They should additionally consider cognitive behavioral therapy, which studies show is as effective as pills.

While the experts admit there is a small number of insomniacs who need medication indefinitely, most people can return to drug-free sleep after a few days or weeks of treatment, using a pill only occasionally for an especially wired night. "We take people off medications all the time," Kavey says. "Everything gets regrooved. The sleep cycle can rework itself." I'm proof this is true. It's been a long time since I took a pill: Immaculate sleep hygiene and therapy seem to have quieted the thoughts that used to haunt me in the wee hours. I sort of miss sleeping pills, but I don't miss insomnia.